[HSF] Persistant Hyperkalemia

Sat Nov 4 22:42:09 EST 2006

Yes this was a highly controlled condition with a monitored single 
exposure with appropriate measures and monitoring being done. Any way it 
does become important to document the occurrence of hyperkalemia in this 
patient if at any time she is to switch to Heparin for any interim 
surgery or whatever.
Anyway I learnt a new lesson with this and it shall change my proactive 
when hyperkalemia occurs - I will have to include Heparin in the 
differential diagnosis.
Was anyone in the forum ever aware that Heparin causes hyperkalemia ? I 
only knew that it could cause hyponatremia .
Prasanna
Ben Bidstrup wrote:
> This I believe is a planned challenge under highly controlled 
> conditions to determine whether there is an adverse response. 
> Anaesthesia does it not infrequently.
>
>> My comment was far from critical, rather congratulations and welcome 
>> to the brotherhood responsible for most  advances in surgery as 
>> opposed to the politically correct evangelists.
>>  (Imagine how you would have fared if you had submitted your 
>> experiment to an ethics committee?)
>> Don
>> On 04/11/2006, at 12:48 PM, prasannasimha wrote:
>>
>>> I think as men of science -- aren't we doing it all the time ?
>>> Prasanna
>>>
>>> Donald Ross wrote:
>>>> Prasanna, welcome to the union of unauthorised human experimentation.
>>>> Don
>>>> On 03/11/2006, at 11:46 PM, prasannasimha wrote:
>>>>
>>>>> 8 hours later K back to 3.6.
>>>>> So Heparin given and removed - caused increase and then decrease 
>>>>> in K +.
>>>>> Lesson to remember - Heparin can cause alteration in K metabolism 
>>>>> at least in some patients.
>>>>> S Creat stable and in normal range after stopping PD for over 12 
>>>>> hours
>>>>> Prasanna
>>>>> psimha wrote:
>>>>>> Gave 5000 units of Heparin and no external K source and ongoing 
>>>>>> Lasix infusion (steady state of whatever was going on) K rose 
>>>>>> from 3.4 to 4.8 mmol/dL in 3 hours (was around 3.5 from the last 
>>>>>> six hours prior to the Heparin). So Heparin does seem to have a K 
>>>>>> retaining effect.!! I asked them to stop heparin again. If K 
>>>>>> falls now it would demonstrate a probable drug withdrawal effect. 
>>>>>> (Exposure effect removal - decrease in effect).
>>>>>> Prasanna
>>>>>> psimha wrote:
>>>>>>> Poked the skunk - gave her Heparin now 5000 U - will let you all 
>>>>>>> know tomorrow - doing serial K let us see. Did it since I have 
>>>>>>> the PD catheter in place and planning to remove the PD catheter 
>>>>>>> tomorrow. Better to have it in and give Heparin once than 
>>>>>>> without !!
>>>>>>> Prasanna
>>>>>>> Ben Bidstrup wrote:
>>>>>>>> Given the nature of the disease, is there a risk that at some 
>>>>>>>> stage in the future heparin might be needed? Double valve etc. 
>>>>>>>> It may be valuable to document a true cause and effect rather 
>>>>>>>> than a putative association. If severe, then a recommendation 
>>>>>>>> in the future for a direct thrombin inhibitor etc may be life 
>>>>>>>> saving. (I was looking at a case of fatal hyperkalemia on one 
>>>>>>>> of the medical education websites. This was due to an ACE 
>>>>>>>> inhibitor being used in heart failure. Admittedly heparin 
>>>>>>>> should only be used in hospital and hopefully carefully 
>>>>>>>> monitored.)
>>>>>>>>
>>>>>>>>> Very appealing and I thought of it but should I risk it ??
>>>>>>>>> Prasanna
>>>>>>>>> Ben Bidstrup wrote:
>>>>>>>>>> You could re-expose to heparin and see what happens.
>>>>>>>>>>
>>>>>>>>>>> Michael
>>>>>>>>>>> Patient has stabilized. I was suggested by the CCML group to 
>>>>>>>>>>> rule out type 4 renal tubular acidosis and while doing a bit 
>>>>>>>>>>> of research on that I found out a list of Aldosterone 
>>>>>>>>>>> antagonists included Heparin. I stopped Heparin in the 
>>>>>>>>>>> flushes and the  K values came crashing down within 3 hours 
>>>>>>>>>>> (we were struggling to get it down till then). Was it a 
>>>>>>>>>>> coincidence - I do not know but it truly decreased in 
>>>>>>>>>>> association (temporally) with stopping Heparin.
>>>>>>>>>>> Prasanna
>>>>>>>>>>> Michael Firstenberg wrote:
>>>>>>>>>>>> now that you are 2 days into this -
>>>>>>>>>>>> any better/worse?
>>>>>>>>>>>> anything manifest itself?
>>>>>>>>>>>>
>>>>>>>>>>>> m
>>>>>>>>>>>>
>>>>>>>>>>>>
>>>>>>>>>>>> On 11/2/06, Dr. Roberto Battellini 
> <battr at medizin.uni-leipzig.de> wrote:
>>>>>>>>>>>>>
>>>>>>>>>>>>> How high are CPK and CPKMB?
>>>>>>>>>>>>> Roberto
>>>>>>>>>>>>>
>>>>>>>>>>>>> -----Ursprüngliche Nachricht-----
>>>>>>>>>>>>> Von: openheart-l-bounces at lists.hsforum.com
>>>>>>>>>>>>> [mailto:openheart-l-bounces at lists.hsforum.com] Im Auftrag von
>>>>>>>>>>>>> prasannasimha
>>>>>>>>>>>>> Gesendet: Mittwoch, 1. November 2006 16:11
>>>>>>>>>>>>> An: ccm; OpenHeart-L at lists.hsforum.com
>>>>>>>>>>>>> Betreff: [HSF] Persistant Hyperkalemia
>>>>>>>>>>>>>
>>>>>>>>>>>>> Double valve replacement with 
> Tricuspid annuloplasty done 2 days back.
>>>>>>>>>>>>> Uneventful post op and extubated on 5 
> mics of dobutamine and dopamine.
>>>>>>>>>>>>> Started getting hyperkalemia since today 3 AM. No clinical or
>>>>>>>>>>>>> biochemical evidence of low 
> output/hemolysis. Urine clear.Echo normal -
>>>>>>>>>>>>> no evidence of paravalvar leak . 
> Lactate 2.7 mmol. Creat 1.5 mg/dL and
>>>>>>>>>>>>> BUN 43 mg/dL
>>>>>>>>>>>>> Initially manged hyperkalemia with 
> Lasix , Calcium , glucose Insulin
>>>>>>>>>>>>> Alkalinizaation K binding resin etc but K went upto 6.8 so 
>>>>>>>>>>>>> started
>>>>>>>>>>>>> PDtoday mrning. K+ dropped to 5.1 but 
> now despite good extraction on PD
>>>>>>>>>>>>> , good urine etc last K+ just done 
> now is 6.0. Cannot identify the cause
>>>>>>>>>>>>> of such persistant hyperkalemia. I 
> have removed all nephrotoxic drugs.
>>>>>>>>>>>>> No additional K + sources and I have 
> specifically asked K free diet.
>>>>>>>>>>>>> Any ideas/suggestions.
>>>>>>>>>>>>> Prasanna
>>>>>>>>>>>>>
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